Dr ERIK MONASTERIO writes of his concern about the impacts of the Trans Pacific Partnership Agreement in trade on New Zealand's health system costs.

OPINION:
Here in New Zealand, we have a proud history of taxpayer-funded, quality public health care.

Even if we don't always love how our public health care system works, for most people it does . . well . . . work. The medicines, care, surgical and other procedures that keep people as healthy as possible, get them well when they are sick, and help them live better lives, are generally available to all, regardless of income level, insurance status or location.

New Zealanders who travel to the United States, or more recently, just turn on the news and hear about "Obamacare", are often shocked at the out-of-pocket costs that Americans can face for services, tests, prescriptions and procedures.

One of the things that stops health costs spiralling out of control here is the tight hold that the Government purchasing agency, Pharmac, has on the market.

The $30 million plus a year that Pharmac saves through careful bulk purchasing pays for a raft of tests, medicines, health services and procedures. So anything that makes it hard for Pharmac to do its job impacts many New Zealanders.

The Trans Pacific Partnership Agreement (TPPA), currently under negotiation, could remove much of Pharmac's power, and put it in the hands of international drug companies - something that should concern us all.

New Zealand is one of 12 countries from Asia and the Pacific Rim currently negotiating the agreement. The negotiations have been conducted behind closed doors, and details are sparse, beyond what has been leaked to the media.

There are worrying indications that pharmaceutical companies - known for their deep pockets and high-pressure tactics - may be wielding undue influence over the talks.

If nothing else, it is deeply concerning that we are hearing so little about what goes on at the TPPA talks, especially given the many facets of life that could be adversely affected by their outcome.

Under another part of the TPPA, multinational corporations could use investor-state settlement mechanisms to sue governments for compensation in international tribunals.

Already a US drug company is seeking C$500m (NZ$535m) for alleged "discrimination" against it in Canada, after it revoked patents for two drugs that were not delivering the expected results (and failed to satisfy the tests required by Canada's domestic law).

This is hardly surprising. "Big Pharma" will always behave like Big Pharma - we have to expect that. It's their job to maximise their profits, at every opportunity. They promise their shareholders that they will do that, and they will do almost anything to achieve it.

The TPPA plays into their hands. ABC news reports suggest it is designed to deal with "behind-the-border impediments" - another phrase for national sovereignty.

Are we willing to enter into such an agreement at the expense of our national health, wellbeing and independence in such a critical area of life?

What are we willing to do to stop multinational corporates - or anyone else, for that matter - from being given the power to put a wrecking ball through key parts of our health system?

None of us can opt out of the public health system completely, when some of our most unexpected, critical health decisions happen within it.

Dedicated doctors and nurses do their absolute best, every day, with the tools and resources at their disposal, defined by the limitations of the health budgets and policies that were debated, set, approved or simply let happen by today's politicians and health policymakers.

That should give all of us pause for thought from time to time: especially those who are shaping the health services of tomorrow.

A far-off trade deal in a distant land may seem a million miles away from a GP visit, prescription, X-ray form or specialist invoice, but its impacts are closer than we all know.

Next time you see a dollar figure on a health receipt, use it as a reminder to learn a bit more, take a bit more notice of how health services are funded, and if you are so inclined, to do a bit more about the TPPA.

Demand to know more about New Zealand's participation in the talks, so you can make up your own mind about what you think. Its impacts go way beyond healthcare - there may well be other aspects that concern you.

Write to MPs, the Trade Minister and Prime Minister and encourage them to tell all of us more about what is going on around the TPPA table. We need to give them the message that, if we sign up for it at all, let's make this an agreement that serves New Zealanders and their health well.

Our children and grandchildren will thank us for it.

Erik Monasterio is a consultant in forensic psychiatry and co-author of Pharmaceutical industry behaviour and the Trans Pacific Partnership Agreement, which appeared in last month's New Zealand Medical Journal. This article was written on behalf of the executive of the Canterbury Hospitals Medical Staff Association.